prednisone and rai

[trish58]

Hi, Dr. Lupo,

I am going to have to do RAI treatment for Graves disease.  My question is, how much prednisone (and for how long) do you prescribe before and after treatment.  Do you recommend prednisone for everyone, or only for those with eye disease?   My endo said that he thinks the risk of prednisone is greater than the risk of eye disease and doesn't want to prescribe it.  I do not feel comfortable with that statement, as eye disease seems much worse to me than short term prednisone.  He also stated that ATD's are a horrible medicine and that he wouldn't suggest them as he has seen too many patients with serious side effects, in particular, bone marrow suppression.  Do you agree with any of this?  Thanks so much for any info, this is all very confusing and scary.

[Mark Lupo, M.D.]

If you have evidence of eye disease, then prednisone would be the standard of care.  If not, then it is not recommended.  The dose varies from study to study, but the landmark study used 30mg/day for up to 3 months!  We tend to use 30-60mg (depending on severity) starting 1-2 weeks before RAI (necessity debated, but I think it helps) and taper based on clinical status usually over a two month period.

I have certainly seen immunosuppression w/ ATDs but most patients do quite well and there is a quiet trend even in the USA to use less RAI and use more ATDs and surgery - but RAI is still the most common recommendation.

[ar1281a]

The treatment of choice in Europe is to start with ATD as you have approx a 50% chance to achieve remission within 15-18 months.

http://www.****.org

RAI can aggravate TED

If I were you, I'd start with ATD (Tapazole rather than PTU) and ask your Dr to monitor your blood closely (side effects are rare, but can happen).

I'm sure Dr. Lupo will give you some great advice.